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Claims Examiner - Workers Compensation - REMOTE

  • Location: Syracuse, 13214
  • Salary: 0
  • Job Type:Contract

Posted 22 days ago

Position: Claims Examiner - Workers Compensation
Location: Syracuse, NY 13214 / Remote
Term: Full Time

Day-to-Day Responsibilities:
  • Analyze complex or technically difficult workers' compensation claims to determine benefits due.
  • Work with high exposure claims involving litigation and rehabilitation.
  • Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
  • Identify subrogation of claims and negotiate settlements.
  • Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Manage claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiate settlement of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims. Manage reserve adequacy throughout the life of the claim.
  • Calculate and pay benefits due. Approve and make timely claim payments and adjustments. Settle clams within designated authority level.
  • Prepare necessary state fillings within statutory limits.
  • Manage the litigation process. Ensure timely and cost effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Report claims to the excess carrier. Respond to requests of directions in a professional and timely manner.
  • Communicate claim activity and processing with the claimant and the client. Maintain professional client relationships.
  • Ensure claim files are properly documented and claims coding is correct.
  • Refer cases as appropriate to supervisor and management.
  • Perform other duties as assigned.
  • Support the organization's quality program(s).
  • Travel as required.

Is this a good fit? (Requirements):
  • Must have a valid NY Adjuster's License.
  • 2+ years of experience handling NY Worker's Compensation lost time claims.
  • 3 years of claims management experience or equivalent combination of education and experience required.
  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Excellent oral and written communication, including presentation skills.
  • PC literate, including Microsoft Office products.
  • Ability to meet or exceed Service Expectations.

Even better if you have:
  • Bachelor's degree from an accredited college or university.